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[Thoracic empyema in very old patients: two types of clinical presentation]
G Gavazzi1, O Orliaguet, M Coume
1Service de médecine interne et de gérontologie clinique, département de médecine communautaire, hôpital A.-Michallon, CHU, 38000 Grenoble, France. gavazzig@hotmail.com
Introduction:
Primitive thoracic empyema or empyema secondary to pneumonia represents a significant medical problem necessitating prolonged hospitalizations and increasing the rates of morbidity and mortality. Average patient age is 55 years and remains rare in very old patients (> 85). We report here two observations in very old patients, pointing out the diversity of the clinical presentation.
Exegesis:
Empyema thoracis is classically associated with underlying diseases. It is often polymicrobial but Gram-positive bacteria and anaerobes are more frequent than Gram-negative bacteria. The clinical presentation may be aspecific without any parameters in favor of infectious disease: the rapidity of pleural drainage and antibiotic therapy are the main prognostic factors.
Conclusion:
Because of the diversity of clinical presentation in the elderly population, and because of the efficiency of rapid treatment, geriatric physicians should perform an examination of pleural fluid when pleural effusion is unknown.